Question 1

What is palliative care?

Accepted Answer

Palliative care is specialised medical care focused on providing relief from pain, symptoms and stress of serious illness — improving the quality of life of patients and their families. It is not limited to end of life: WHO recommends integrating palliative care early in the course of any serious illness alongside curative treatment. The goal is not hastening or delaying death but ensuring that life — however long it lasts — is as comfortable and meaningful as possible.

Question 2

How many people need palliative care?

Accepted Answer

An estimated 40 million people need palliative care each year — yet only 14% receive it. 78% of global palliative care need is in LMICs, where services are nearly non-existent. The primary conditions driving need are cancer (14 million), cardiovascular disease (8 million), COPD (5 million), HIV/AIDS (2.7 million) and dementia (2.6 million).

Question 3

What is the morphine access crisis?

Accepted Answer

83% of the world's medical morphine is consumed by just 10% of the population — in high-income countries. In most LMICs, oral morphine — the WHO essential medicine for cancer pain relief, costing less than $1 per day — is unavailable or subject to regulatory barriers so onerous that prescribers refuse to use it. Millions of cancer patients die in unnecessary, preventable pain. Regulatory reform to ensure opioid availability while preventing diversion is a WHO and INCB priority.

Question 4

Is palliative care only for cancer patients?

Accepted Answer

No — while cancer is the leading condition driving palliative care need, palliative care is appropriate for anyone with a life-limiting illness causing suffering. Other major conditions requiring palliative care include: cardiovascular disease (heart failure, post-stroke); COPD and other respiratory disease; HIV/AIDS; dementia; kidney failure; liver failure; and motor neuron disease. The WHO definition explicitly covers all life-threatening illness.

Question 5

Does early palliative care improve survival?

Accepted Answer

A landmark NEJM study (Temel et al., 2010) in advanced non-small-cell lung cancer showed that patients receiving early integrated palliative care alongside standard oncology care had significantly better quality of life, less depression — and lived 2.7 months longer than those receiving standard care alone. This study transformed the understanding of palliative care: it is not about "giving up" but about optimising quality of life and potentially allowing better tolerance of treatment.

Question 6

What are the barriers to palliative care access?

Accepted Answer

Key barriers: strict opioid regulation preventing access to morphine; lack of palliative care training in medical and nursing curricula; absence of palliative care services in health systems; social and cultural taboos around death and dying; lack of national policies and financing; prioritisation of curative over comfort care; and stigma around opioid use. In many LMICs, none of the necessary conditions for palliative care — trained staff, essential medicines, policies, financing — are present.

Question 7

What is hospice care?

Accepted Answer

Hospice care is a specific type of palliative care provided to people with a terminal prognosis (typically 6 months or less) who have decided to focus on comfort rather than curative treatment. It may be delivered at home (home hospice — the most common mode globally), in dedicated hospice facilities, in nursing homes or in hospitals. The hospice movement was pioneered by Dame Cicely Saunders in the UK in the 1960s.

Question 8

What is advance care planning?

Accepted Answer

Advance care planning (ACP) involves conversations — between patients, families and healthcare providers — about the patient's values, goals and preferences for future medical care, particularly if they lose the ability to communicate. Advance directives, living wills and health care proxies formalise these wishes. ACP reduces unwanted aggressive interventions at end of life, increases concordance between patient wishes and care received, and reduces family distress.

Question 9

Is palliative care part of UHC?

Accepted Answer

WHO explicitly recognises palliative care as a core component of universal health coverage and has placed opioid analgesics on the Essential Medicines List. WHA Resolution 67.19 (2014) called on all member states to integrate palliative care into their health systems. The Lancet Commission on Palliative Care and Pain Relief (2017) identified palliative care as a health system priority, emphasising the role of community-based care and training.

Question 10

What is the WHO pain ladder?

Accepted Answer

WHO's three-step analgesic ladder (1986) provides a practical framework for cancer pain management: Step 1 (mild pain): non-opioids (paracetamol, NSAIDs); Step 2 (moderate pain): weak opioids (codeine or low-dose strong opioid) plus non-opioid; Step 3 (severe pain): strong opioids (oral morphine, oxycodone) plus non-opioid. This simple, affordable framework could relieve most cancer pain globally if essential medicines were accessible.

Question 11

What is the INCB and opioid access?

Accepted Answer

The International Narcotics Control Board (INCB) monitors global trade in controlled substances — including medical opioids. It publishes annual reports on morphine consumption by country. Most LMICs appear in the lowest consumption categories — not because cancer pain is absent, but because regulatory barriers, lack of prescriber training and supply chain gaps prevent access. INCB actively advocates for "balance" — preventing diversion while ensuring adequate medical access to opioids.

Question 12

How does GMJ News cover palliative care?

Accepted Answer

GMJ News covers WHO palliative care policy, morphine access equity, Lancet Commission recommendations, advance care planning, and integration of palliative care into Georgian cancer and NCD programmes. Palliative care access in Georgia — for cancer patients and those with serious illness — is a direct PHIG and Georgian Medical Journal editorial priority.

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